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Short stay and less pain after ambulatory anterior cruciate ligament ( ACL ) repair: COX‐2 inhibitor versus glucocorticoid versus both combined
Author(s) -
DAHL V.,
SPRENG U. J.,
WAAGE M.,
RAEDER J.C.
Publication year - 2012
Publication title -
acta anaesthesiologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.738
H-Index - 107
eISSN - 1399-6576
pISSN - 0001-5172
DOI - 10.1111/j.1399-6576.2011.02584.x
Subject(s) - medicine , anterior cruciate ligament , ketorolac , ambulatory , anesthesia , dexamethasone , acl injury , analgesic , general anaesthesia , visual analogue scale , surgery
Background Many studies have demonstrated that either COX‐2 antagonists or glucocorticoids are efficient analgesics after orthopaedic surgery. We wanted to evaluate if the combination of these two drugs was better than one drug alone when added to paracetamol, local anaesthesia, and cryo‐cuff for outpatient anterior crucial ligament ( ACL ) surgery. Methods In a double‐blind design, 89 adult patients scheduled for day‐case ACL repair in general anaesthesia were randomly assigned into three groups: The COXIB group ( n = 30) received either 40 mg parecoxib iv or 120 mg etoricoxib orally 1 h before surgery. The STEROID group ( n = 30) received 8 mg dexamethasone iv, and the combination group (Group COMBI , n = 29) received both. Results At 24 h, G roup COMBI had significantly lower visual analogue scale (0–10 cm) scores during rest (2.1 ± 1.3) (mean ± standard deviation) and movement (4.2 ± 2.5) when compared to both the COXIB group ( P = 0.04) and the STEROID group ( P = 0.035). The accumulated consumption of rescue opioids (5.2 ± 4,5 mg morphine) was also significantly lower at 24 h compared to the other groups ( P = 0.02). Mean time to discharge from hospital was about 3 h in all groups. The pain scores in the post‐anaesthetic care unit, mobilization at 24 h and 7 days, and general level of satisfaction were similar between the groups. Conclusion The combination of a COX‐2 inhibitor and dexamethasone results in better pain relief 24 h after surgery in patients undergoing outpatient ACL surgery, compared to COX‐2 inhibitor alone or dexamethasone alone. With a dedicated multimodal pain regime, most ACL patients may be discharged within 3 h.